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P�RMIT APPLICATIG��J <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 (/ � r s��(� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> I I v Co r ��-u., C/�/' 2-/ <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS, 21P PHONE <br /> C�.� (�,e I z, I i � �.��,� b��( ��,�. 9�zo I 4 zs-�g3 � �a <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��a,n.+/ l�� e. ( �ru ��e.� � ZS-78 3-�60 <br /> CONTRACTOR ADDRESS 21P CONTR.LICENSE# <br /> PHONE <br /> PROPOSED USE uF BUILDING �uilding fl tviechanical Addilion HEAT SOURCE <br /> PERMIT Combinalion F_� Plumbing WORK Alteration II'—'L1 Electric <br /> TYPE � Demulition U Sign TYPE New �j� Gas <br /> Sprinkler RepaidMaint. U Olher <br /> CONTRACT PRICE OF WORI< CITY OF EVERETT'LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANGLING UNITS <br /> BATI'TU8 � FORCED AIR SYSTEMS <br /> tAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASfiER RANGE HOOD <br /> LAUNDRYTRAY � WATERHEATER <br />� CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS R.4NGE <br /> BACf<FLOW PREVE�TER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I <br /> II I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATIOPJ AND KNOW THE SAMf TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK VJILt.BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR i <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLITE OR CANCEI THE PROVISION OF AIJY OTHER I <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1 . C6v AND 296200 WAC. <br /> � �`� i �/ �l -�S"� � ( <br /> Signature of nedContractodAuthorized Agent Date <br /> DFBIT & CREDIT CARDS ARE NOT ACCEPTED <br />